Behavioral weight loss outcomes in individuals with binge-eating disorder: A meta-analysis

OBJECTIVE

Binge-eating disorder (BED) is highly comorbid with obesity. Weight loss may benefit individuals with BED; however, these individuals are often excluded from behavioral weight loss interventions (BWLIs), and findings from BWLIs including participants with and without BED are mixed. To the authors' knowledge, this study represents the first meta-analysis of weight loss outcomes of individuals with and without BED in BWLIs, while adjusting for weight-influencing variables. Treatment dropout rates were also examined.

METHODS

Electronic search engines and grey literature search methods were used to identify manuscripts published through December 2022 related to BWLIs and BED. Thirty manuscripts (BED n = 1519; 25 non-BED n = 6345) were included.

RESULTS

A meta-regression found that individuals with BED lost less weight compared with individuals without BED (~1.4 kg; ~2.9 kg among studies without meal replacements), but they still lost ~8.1 kg at post-treatment. A random-effects model showed that BED diagnosis increased odds of treatment dropout by 50%.

CONCLUSIONS

BWLIs produced robust weight loss in those with BED, but those with BED lost less weight and had higher risk of dropout compared with those without. Future research should aim to close the gap in weight loss outcomes and retention between those with and without BED.

Sleep Well! An adapted behavioral sleep intervention implemented in urban primary care

STUDY OBJECTIVES

To describe the adaptation, feasibility, and initial outcomes of Sleep Well!, an intervention for early childhood insomnia and insufficient sleep, designed for families from lower-socioeconomic status (SES) backgrounds presenting to large metropolitan primary care sites.

METHODS

Fifteen caregiver-child dyads (caregivers: 92.3% mothers; 80.0% Black; 53.3% ≤125% US poverty level; children: 73.3% female; 86.7% Black; M age = 3.0 years) participated this multi-method, single-arm trial. A family advisory board of caregivers (N = 4) and a clinician advisory board of sleep experts, primary care clinicians, and psychologists (N = 13) provided intervention feedback throughout the pilot. Most adaptations were related to intervention delivery methods, with some related to sleep strategies. At post-intervention, caregivers completed surveys on intervention acceptability and cultural humility (primary outcomes) and completed semi-structured interviews. Caregivers also reported on child sleep pre- and post-intervention.

RESULTS

Thirteen (86.6%) families completed Sleep Well! and 12 (80.0%) completed pre- and post-intervention measures. Caregivers reported strong intervention acceptability and cultural humility. There were pre-to-post reductions in child sleep problems, bedroom electronics, sleep onset latency, and night awakening frequency and duration. Nighttime sleep duration and overall insufficient sleep also improved. Qualitative data also showed strong intervention acceptability and perceived flexibility, with few participation barriers.

CONCLUSIONS

A brief, early childhood behavioral sleep intervention delivered in primary care with families from primarily lower-SES and/or racially minoritized backgrounds is feasible to implement, with strong retention rates, acceptability, and perceptions of cultural humility. Child sleep improvements are positive, and warrant replication in a randomized controlled trial.

Impulsivity and affect reactivity prospectively predict disordered eating attitudes in adolescents: a 6-year longitudinal study

Eating disorders (EDs) are associated with significant psychological and physical comorbidities, and adolescence is a particularly high-risk time for the development of EDs. Impulsivity (i.e., acting with little conscious judgment or forethought) and affect reactivity (i.e., changes in negative affect in response to a stressor) are hypothesized to contribute to the development of binge/purge ED pathology. The current study is the first to examine the prospective relationships between impulsivity and affect reactivity as predictors of the development of ED attitudes in adolescents over time. Two hundred six adolescents participated in a longitudinal study examining the development of psychopathology. ED attitudes were assessed via the College Eating Disorders Screen annually for 6 years. Baseline impulsivity and affect reactivity were also assessed. Affect reactivity, impulsivity, and their interaction were examined as baseline predictors of changes in ED attitudes over time using latent growth modeling. Results of latent growth modeling indicated that ED attitudes increased over time. The interaction between impulsivity and affect reactivity significantly predicted the slope of ED attitudes, such that the relationship between impulsivity and ED attitudes was strongest for those with elevated levels of affect reactivity. Findings suggest that greater levels of affect reactivity and impulsivity are key risk factors for the development of ED attitudes in adolescents. Subsequent research should examine the relation between affect reactivity and impulsivity in predicting objectively measured ED behaviors, in addition to ED attitudes. Further investigation may implicate affect reactivity and impulsivity as important targets for early intervention to prevent onset of ED symptoms in adolescents.

OnTrack: development and feasibility of a smartphone app designed to predict and prevent dietary lapses

Given that the overarching goal of weight loss programs is to remain adherent to a dietary prescription, specific moments of nonadherence known as "dietary lapses" can threaten weight control via the excess energy intake they represent and by provoking future lapses. Just-in-time adaptive interventions could be particularly useful in preventing dietary lapses because they use real-time data to generate interventions that are tailored and delivered at a moment computed to be of high risk for a lapse. To this end, we developed a smartphone application (app) called OnTrack that utilizes machine learning to predict dietary lapses and deliver a targeted intervention designed to prevent the lapse from occurring. This study evaluated the feasibility, acceptability, and preliminary effectiveness of OnTrack among weight loss program participants. An open trial was conducted to investigate subjective satisfaction, objective usage, algorithm performance, and changes in lapse frequency and weight loss among individuals (N = 43; 86% female; body mass index = 35.6 kg/m2) attempting to follow a structured online weight management plan for 8 weeks. Participants were adherent with app prompts to submit data, engaged with interventions, and reported high levels of satisfaction. Over the course of the study, participants averaged a 3.13% weight loss and experienced a reduction in unplanned lapses. OnTrack, the first Just-in-time adaptive intervention for dietary lapses was shown to be feasible and acceptable, and OnTrack users experienced weight loss and lapse reduction over the study period. These data provide the basis for further development and evaluation.

Rates of cerebral protein synthesis in primary visual cortex during sleep-dependent memory consolidation, a study in human subjects

If protein synthesis during sleep is required for sleep-dependent memory consolidation, we might expect rates of cerebral protein synthesis (rCPS) to increase during sleep in the local brain circuits that support performance on a particular task following training on that task. To measure circuit-specific brain protein synthesis during a daytime nap opportunity, we used the L-[1-(11)C]leucine positron emission tomography (PET) method with simultaneous polysomnography. We trained subjects on the visual texture discrimination task (TDT). This was followed by a nap opportunity during the PET scan, and we retested them later in the day after the scan. The TDT is considered retinotopically specific, so we hypothesized that higher rCPS in primary visual cortex would be observed in the trained hemisphere compared to the untrained hemisphere in subjects who were randomized to a sleep condition. Our results indicate that the changes in rCPS in primary visual cortex depended on whether subjects were in the wakefulness or sleep condition but were independent of the side of the visual field trained. That is, only in the subjects randomized to sleep, rCPS in the right primary visual cortex was higher than the left regardless of side trained. Other brain regions examined were not so affected. In the subjects who slept, performance on the TDT improved similarly regardless of the side trained. Results indicate a regionally selective and sleep-dependent effect that occurs with improved performance on the TDT.

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors

PURPOSE

Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time.

METHOD

Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI.

RESULTS

Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet.

CONCLUSION

We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed.

Promising technological innovations in cognitive training to treat eating-related behavior

One potential reason for the suboptimal outcomes of treatments targeting appetitive behavior, such as eating and alcohol consumption, is that they do not target the implicit cognitive processes that may be driving these behaviors. Two groups of related neurocognitive processes that are robustly associated with dysregulated eating and drinking are attention bias (AB; selective attention to specific stimuli) and executive function (EF; a set of cognitive control processes such as inhibitory control, working memory, set shifting, that govern goal-directed behaviors). An increasing body of work suggests that EF and AB training programs improve regulation of appetitive behaviors, especially if trainings are frequent and sustained. However, several key challenges, such as adherence to the trainings in the long term, and overall potency of the training, remain. The current manuscript describes five technological innovations that have the potential to address difficulties related to the effectiveness and feasibility of EF and AB trainings: (1) deployment of training in the home, (2) training via smartphone, (3) gamification, (4) virtual reality, and (5) personalization. The drawbacks of these innovations, as well as areas for future research, are also discussed. The above-mentioned innovations are likely to be instrumental in the future empirical work to develop and evaluate effective EF and AB trainings for appetitive behaviors.

Executive functioning and dietary intake: Neurocognitive correlates of fruit, vegetable, and saturated fat intake in adults with obesity

Obesity is a significant public health issue, and is associated with poor diet. Evidence suggests that eating behavior is related to individual differences in executive functioning. Poor executive functioning is associated with poorer diet (few fruits and vegetables and high saturated fat) in normal weight samples; however, the relationship between these specific dietary behaviors and executive functioning have not been investigated in adults with obesity. The current study examined the association between executive functioning and intake of saturated fat, fruits, and vegetables in an overweight/obese sample using behavioral measures of executive function and dietary recall. One-hundred-ninety overweight and obese adults completed neuropsychological assessments measuring intelligence, planning ability, and inhibitory control followed by three dietary recall assessments within a month prior to beginning a behavioral weight loss treatment program. Inhibitory control and two of the three indices of planning each independently significantly predicted fruit and vegetable consumption such that those with better inhibition and planning ability consumed more fruits and vegetables. No relationship was found between executive functioning and saturated fat intake. Results increase understanding of how executive functioning influences eating behavior in overweight and obese adults, and suggest the importance of including executive functioning training components in dietary interventions for those with obesity. Further research is needed to determine causality as diet and executive functioning may bidirectionally influence each other.

Nutrition Assessment: Experience Is Not a Predictor of Knowledge

This study tested an evidence-based nutrition education program for licensed nurses working in nursing homes who scored an average of 56% on a pretest. Posttest scores averaged 66%, demonstrating a continuing deficit of basic nutritional knowledge despite the educational intervention. Statistical analysis revealed that less experienced nurses scored better on posttests than more experienced nurses; more experienced nurses performed nutritional assessment more often than less experienced nurses; and more experienced nurses were usually charge nurses or nurses completing Minimum Data Sets. Although the education did not eliminate all deficits in nutrition knowledge, a decrease in the percentage of residents with significant weight loss was noted.

Storytelling as cultural assessment

This article describes how story was used to teach cultural assessment to baccalaureate nursing students enrolled in clinicals in long-term care facilities. Class sessions focused on learning to elicit and listen to patients' stories and use story as an assessment tool in clinical practice. With their peers, students learned to listen in a nonjudgmental, contextual way to the values and beliefs of the storyteller. They learned that all people, even those from the dominant mainstream culture, have stories to tell, and that stories build bridges between nurses and clients.

Quality improvement practices: enhancing quality of life during mealtimes

This article describes ten dining room problems, identified in a nursing home study, that needed quality improvement, as well as six quality practices suggested for implementation. These six quality practices provide the basis for an excellent eating experience characterized by a home-like atmosphere, high levels of staff-resident interaction, and increased attention to safety and ethical issues. The six practices also could serve as the foundation for a facility-wide, cost-effective, quality improvement program.

Body and carcass composition of Angus and Charolais steers as affected by age and nutrition

The objectives of this study were to examine the effects of a low vs moderate rate of gain during the growing phase on empty body and carcass composition during finishing of Angus and Charolais steers of two ages. Forty-eight Angus and 48 Charolais steers that were either spring-born (OLDER) or fall-born (YOUNGER) were fed two diets (alfalfa pellets [CON] or cubed grass-alfalfa hay, wheat straw, cottonseed hulls, and soybean meal [RES]) for a growing period followed by a conventional feedlot period. The feedlot period started when the YOUNGER-CON steers weighed the same as the OLDER-RES steers. At that time, an interaction of age x diet occurred in empty body fat content (P < .10), whereas breed and age x diet affected carcass fat content (P < .01). OLDER-CON steers were larger (average 378 kg empty BW) and fatter than the other, smaller groups (average 222 kg). Angus carcasses were fatter than Charolais carcasses (P < .01). At the end of the finishing phase, compensating steers (OLDER-RES) had fatter carcasses than OLDER-CON steers. Empty body fat content was affected by a breed x age x diet interaction (P < .10). Allometric regressions (Y = aXb) of fat on empty BW indicated that empty body fat accretion was greater in Angus than in Charolais and in YOUNGER than in OLDER steers. A breed x age x diet interaction (P < .10) indicated that OLDER-Angus had higher fat accretive rates than YOUNGER-Angus, whereas OLDER-CON-Charolais steers deposited fat more slowly than the remaining groups. These data suggest that steers receiving feedlot diets at light weights, whether young in age or previously restricted, accumulate fat more rapidly than do larger steers. This feeding strategy may be an advantage in late-maturing types, but moderate growth through approximately 75% of slaughter weight is recommended for early-maturing types.

Effect of nutrition, age and size on compensatory growth in two breeds of steers

Compensatory gain in cattle was studied to determine if age, previous rate of gain or size were factors of importance. A factorial experiment was conducted with growing diet regimen (control vs restricted), age [spring-born (older) vs fall-born (younger)] and breed (Angus vs Charolais) as the factors. During a growing phase, the two diets, (control = dehydrated alfalfa pellets; restricted = cubed grass-alfalfa hay, cottonseed hulls and soybean meal) were fed to both the older and younger steers of each breed to provide groups of similar age but different weights (growing regimen within age) and groups of similar weights but different ages (older-restricted vs younger-controls) at the time at which the steers were switched to a high concentrate diet. Interactions of breed with age and previous growing regimen diet on digestibility of some nutrients in the finishing diet were evident. During the growing phase, control steers averaged .72 kg/d gain, whereas the restricted steers averaged .25 kg/d. The older-restricted steers compensated (P less than .05) from 30 to 120 d after the beginning of the feedlot phase compared with older-control steers. Rates of gain of younger steers were intermediate to those of the older steers throughout the finish phase and were not influenced by growing diet, except on d 30. Rate of gain during the growing phase was negatively correlated (P less than .05) with rate of gain during the finishing phase (60 to 120 d). Within breed, weight at the beginning of the feedlot phase also was negatively correlated with gain during the finishing phase. Skeletal growth was reduced (P less than.05) by the restricted diet during the growing phase, and small compensation (P greater than .05) was observed during the finishing phase. Feed/gain for restricted steers was slightly lower (P greater than .05) than control steers. Younger steers were more efficient (P less than .05) overall in converting dry matter to gain, due to the relatively shorter growing phase when compared with the older steers. These data indicate that both previous gain and weight upon realimentation are influential on compensatory growth.